title: The cost-effectiveness of the Dose Adjustment for Normal Eating (DAFNE) structured education programme: an update using the Sheffield Type 1 Diabetes Policy Model.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of training in flexible intensive insulin therapy [as provided in the Dose Adjustment for Normal Eating (DAFNE) structured education programme] compared with no training for adults with Type 1 diabetes mellitus in the UK using the Sheffield Type 1 Diabetes Policy Model.
  
  
  METHODS
  The Sheffield Type 1 Diabetes Policy Model was used to simulate the development of long-term microvascular and macrovascular diabetes-related complications and the occurrence of diabetes-related adverse events in 5000 adults with Type 1 diabetes. Total costs and quality-adjusted life years were estimated from a National Health Service perspective over a lifetime horizon, discounted at a rate of 3.5%. The treatment effectiveness of DAFNE was modelled as a reduction in HbA1c that affected the risk of developing long-term diabetes-related complications. Probabilistic and structural sensitivity analyses were conducted.
  
  
  RESULTS
  DAFNE resulted in greater life expectancy and reduced incidence of some diabetes-related complications compared with no DAFNE. DAFNE was found to generate an average of 0.0294 additional quality-adjusted life years for an additional cost of £426 per patient, leading to an incremental cost-effectiveness ratio of £14 400 compared with no DAFNE. There was a 54% probability that DAFNE would be cost-effective at a willingness-to-pay threshold of £20 000 per quality-adjusted life year.
  
  
  CONCLUSIONS
  The results of this study suggest that DAFNE is a cost-effective structured education programme for people with Type 1 diabetes and support its provision by the National Health Service in the UK.
authors.affiliation: School of Health and Related Research, Sheffield, UK.
authors.forename: J
authors.initials: J
authors.lastname: Kruger
authors.forename: A
authors.initials: A
authors.lastname: Brennan
authors.forename: P
authors.initials: P
authors.lastname: Thokala
authors.forename: H
authors.initials: H
authors.lastname: Basarir
authors.forename: R
authors.initials: R
authors.lastname: Jacques
authors.forename: J
authors.initials: J
authors.lastname: Elliott
authors.forename: S
authors.initials: S
authors.lastname: Heller
authors.forename: J
authors.initials: J
authors.lastname: Speight
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003925:Diabetic Angiopathies / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D007328:Insulin / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D018803:Models, Economic; D010353:Patient Education as Topic / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human